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CCO Incentive Metrics:
Alcohol and Drug Misuse (SBIRT)
Assessments for Children in DHS Custody
Childhood Immunization Status
Cigarette Smoking Prevalence
Preventative Dental Services for Children
Depression Screening and Follow-Up Plan
Diabetes Care A1c Poor Control
Disparity Measure Emergency Department Utilization for Individuals Experiencing Mental Illness
Immunization for Adolescents
Initiation and Engagement of Alcohol and Other Drug Use Treatment
Oral Evaluation for Adults with Diabetes
Timeliness of Postpartum Care
Well Child Visits in the Third, Fourth, Fifth and Sixth Years of life
Medicare Stars Metrics:
Breast Cancer Screening
CAHPS: (Access) Consumer Assessment of Healthcare Providers and Systems
Care for Older Adults: Medication Review (COA)
Care for Older Adults: Pain Screening (COA)
Colorectal Cancer Screening (CRC)
Controlling High Blood Pressure
Diabetes Care: Eye Exam
Diabetes Care: Kidney Disease Monitoring
(HOS) Improving Bladder Control
(HOS) Monitoring Physical Activity
(HOS) Reduce the Risk of Falling
Medication Adherence for Cholesterol Statins
Medication Adherence for Diabetes Medications
Medication Adherence for Hypertension
Osteoporosis Management in Women Who had a Fracture (OMW)
Rheumatoid Arthritis Management (ART)
Statin Therapy for Patients with Cardiovascular Disease
Statin Use in Persons with Diabetes (SUPD)
Retired CCO Metrics:
Adolescent Well Care Visits
Colorectal Cancer Screening (CRC)
Controlling High Blood Pressure
Developmental Screening
Effective Contraceptive Use
PCPCH Enrollment
Individual Measures
Adolescent Well Care Visits
Adult BMI Assessment
Alcohol and Drug Misuse (SBIRT)
Ambulatory Care - Emergency Department and Outpatient Utilization
Assessments for Children in DHS Custody
Breast Cancer Screening
CAHPS: (Access) Consumer Assessment of Healthcare Providers and Systems
Medicare Stars CAHPS Questions Categories
Care for Older Adults: Functional Status Assessment
Care for Older Adults: Medication Review
Care for Older Adults: Pain Screening
Childhood Immunization Status
Cigarette Smoking Prevalence
Colorectal Cancer Screening
STOP CRC Implementation Guide
Controlling High Blood Pressure
Dental Sealants
Depression Screening and Follow-Up Plan
Depression Screening and Follow Up (one pager)
Developmental Screening
Developmental Screening Sample Workflows
Diabetes: Eye Exam
Diabetes: HbA1c Poor Control
Diabetes Care: Nephropathy Monitoring
Disparity Measure - Emergency Department utilization for Individuals Experiencing Mental Illness
Effective Contraceptive Use
ECU Surveillance Telephone Strategies
ECU Code Cheat Sheet Template for Printing and Laminating
HOS - Improving Bladder Control
HOS - Monitoring Physical Activity
HOS - Reduce the Risk of Falling
Inpatient & Emergency Department Utilization for Ambulatory Care Sensitive Conditions
Medication Adherence for Cholesterol Statins
Medication Adherence for Diabetes Medications
Medication Adherence for Hypertension
Oral Evaluation for Adults with Diabetes
Osteoporosis
PCPCH Enrollment
Statin Therapy for Patients with Cardiovascular Disease
Timeliness of Prenatal and Postpartum Care
Weight Assessment and Counseling
2022 Metrics Medicaid Toolkit
Adolescent immunizations
Alcohol and drug misuse (SBIRT)
Assessments for children in DHS custody
Child and adolescent well-care visits (WCV)
Childhood immunization status
Cigarette smoking prevalence
Depression screening and follow-up plan
Diabetes: HbA1c poor control
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
Meaningful Access to Health Care Services for persons with limited English proficiency
Oral evaluation for adults with diabetes
Preventive dental or oral services - Ages 1-5 & 6-14
Social-emotional health metric
Timeliness of prenatal and postpartum care
2021 Metrics Toolkit
Adolescent immunizations
Alcohol and drug misuse (SBIRT)
Assessments for children in DHS custody
Breast cancer screening
Care for older adults: Functional status assessment
Care for older adults: Medication review
Care for older adults: Pain screening
Childhood immunization status
Cigarette smoking prevalence
Colorectal cancer screening
Controlling high blood pressure
Depression screening and follow-up plan
Diabetes: Eye exam
Diabetes: HbA1c poor control
Diabetes care: Nephropathy monitoring
Disparity measure: Emergency department utilization for individuals experiencing mental illness
HOS: Improving bladder control
HOS: Monitoring physical activity
HOS: Reduce the risk of falling
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
Inpatient and emergency department utilization for ambulatory care sensitive conditions
Meaningful Access to Health Care Services for persons with limited English proficiency
Medication adherence for cholesterol statins
Medication adherence for diabetes medications
Medication adherence for hypertension
Oral evaluation for adults with diabetes
Osteoporosis
Statin therapy for patients with cardiovascular disease
Timeliness of prenatal and postpartum care
More resources
2022 Medicaid Metrics toolkit
2021 CareOregon Quality Metrics Toolkit
2022-23 CareOregon PCPM Program Description
OHA Metrics:
oregon.gov/oha/HPA/ANALYTICS/Pages/CCO-Metrics.aspx
OHA Transformation Center:
oregon.gov/oha/hpa/csi-tc/pages/index.aspx
Medicare Star Ratings Technical Specs:
cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData
HEDIS Measures:
ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2018
CMS:
cms.gov/
Value sets can be accessed through the Value Set Authority Center (VSAC) at the National Library of Medicine:
vsac.nlm.nih.gov
. Value sets include CPT, HCPC, ICD-9, ICD-10, SNOMED, and RXNORM codes
Quality Improvement:
ihi.org/resources/Pages/default.aspx
Certified Health IT Product List is a resource for determining EMR reporting capacity:
chpl.healthit.gov/#/search
STOP CRC implementation guide
IET Billing guide
Words matter
Recovery oriented language guide
Diabetes and oral health: Improve patient outcomes
Primary care integration holds untold possibilities when we look at the ways member subpopulations could benefit from greater collaboration among their physical, dental and behavioral health providers. In 2019, Health Share of Oregon tasked CareOregon to create the Diabetes Integration Project, a long-term project for members diagnosed with both type II diabetes and severe and persistent mental illness. Here’s a summary of those efforts, led by the CareOregon Innovation Team, and ways these principles can be applied to other provider groups:
Diabetes Integration Project 2019-2021
.